Crosswalk

MCBS Community Additions

MCBS Non-substantive Change Request
Proposed Changes to Community Facility Interviews and Effect on Burden

Community Interview Additions

Section

Addition: follow-up questions to an
existing series on diabetes management

HFQ:
Fall Round

Effect on
Annual
Burden

None

Question Text

Since (LAST HF MONTH YEAR), [have you/has (SP)] had any problems paying or were
unable to pay for insulin?

[Do you/does (SP)] administer [your/their] insulin with…
a syringe, insulin pen, insulin pump, and/or inhaler?

Response Options

(01) YES
(02) NO
(-8) Don't Know
(-9) Refused

(01) SYRINGE
(02) INSULIN PEN
(03) INSULIN PUMP
(04) INHALER
(-8) Don't Know
(-9) Refuse